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WO2010117999A1 - Dispositif médical et technique pour utiliser celui-ci - Google Patents

Dispositif médical et technique pour utiliser celui-ci Download PDF

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Publication number
WO2010117999A1
WO2010117999A1 PCT/US2010/030064 US2010030064W WO2010117999A1 WO 2010117999 A1 WO2010117999 A1 WO 2010117999A1 US 2010030064 W US2010030064 W US 2010030064W WO 2010117999 A1 WO2010117999 A1 WO 2010117999A1
Authority
WO
WIPO (PCT)
Prior art keywords
tracheal tube
tube
coherent light
subject
distance
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2010/030064
Other languages
English (en)
Inventor
Edward Mckenna
Youzhi Li
Andy Lin
Sarah Hayman
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Nellcor Puritan Bennett LLC
Original Assignee
Nellcor Puritan Bennett LLC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Nellcor Puritan Bennett LLC filed Critical Nellcor Puritan Bennett LLC
Publication of WO2010117999A1 publication Critical patent/WO2010117999A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0488—Mouthpieces; Means for guiding, securing or introducing the tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/267—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the respiratory tract, e.g. laryngoscopes, bronchoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0082—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
    • A61B5/0084—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; Determining position of diagnostic devices within or on the body of the patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; Determining position of diagnostic devices within or on the body of the patient
    • A61B5/065—Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/74—Details of notification to user or communication with user or patient; User input means
    • A61B5/742—Details of notification to user or communication with user or patient; User input means using visual displays
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A61M16/0443—Special cuff-wall materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3306—Optical measuring means

Definitions

  • the present disclosure relates generally to medical devices and, more particularly, to airway devices, such as tracheal tubes.
  • a tube or other medical device may be used to control the flow of air, food, fluids, or other substances into the patient.
  • tracheal tubes may be used to control the flow of air or other gases through a patient's trachea.
  • Such tracheal tubes may include endotracheal (ET) tubes, tracheotomy tubes, or transtracheal tubes.
  • ET endotracheal
  • tracheotomy tubes or transtracheal tubes.
  • a patient may be intubated when an endotracheal tube is inserted through the patient's mouth and into the trachea.
  • intubation procedures may be performed during medical emergencies or during critical care situations.
  • healthcare providers may balance a desire for speed of intubation with a desire for accurate placement of the tube within the trachea.
  • proper placement of a tracheal tube may be complex. In certain situations, placement may be aided with visualization of the trachea performed during laryngoscopy.
  • a practitioner may employ a lighted laryngoscope during introduction of the endotracheal tube.
  • FIG. 1 illustrates an exemplary system including an endotracheal tube with a coherent light source and detector according to embodiments
  • FIG. 2 is a schematic diagram of an interferometer that may be coupled to a tracheal tube according to embodiments;
  • FIG. 3 is a flow diagram of a method of operating a tracheal tube according to embodiments
  • FIG. 4 is a perspective view of an exemplary endotracheal tube of FIG. 3.
  • FIG. 5 is a perspective view of an exemplary distal tip of a tracheal tube with embedded optical fibers that may be coupled to a coherent light source and photodetector.
  • a tracheal tube may be used to seal a patient's airway and provide positive pressure to the lungs when properly inserted into a patient's trachea. Positioning the tracheal tube at a desired position within the trachea, for example during endotracheal intubation, may improve the performance of the tracheal tube and reduce clinical complications.
  • the distal inserted end of the endotracheal tube may be positioned in the patient's trachea at a location substantially between the patient's vocal cords and carina. If the tube cuff is not inserted far enough past the vocal cords, for example, the tube may become more easily dislodged.
  • the tube may only function to adequately ventilate one of the lungs, rather than both.
  • proper placement of the distal tip of the tube may result in improved ventilation to the patient.
  • tracheal tubes and systems for facilitating proper placement of the tracheal tube relative to certain anatomical structures in and around the patient's airway and trachea.
  • Such tracheal tubes may include assemblies for shining coherent light into the trachea and detecting the returned light. The light is returned after being reflected/scattered by internal tissues of the patient (such as the tissues in the vicinity of the carina). Accordingly, information related to the detected light, for example its phase relative to a reference, may be used to determine a distance from the tube to the anatomical structure in question. In embodiments, a distance from the distal end of the tracheal tube to the carina (or other internal anatomical structure or tissue) may be determined. A healthcare provider may then use the information about the location of the tracheal tube relative to the anatomical structures (e.g., the carina) to determine whether the tube is properly placed or whether the position of the tube should be adjusted.
  • the anatomical structures e.g., the carina
  • the disclosed tracheal tubes, systems, and methods may be used in conjunction with any appropriate medical device, including without limitation a feeding tube, an endotracheal tube, a tracheotomy tube, a circuit, an airway accessory, a connector, an adapter, a filter, a humidifier, a nebulizer, nasal cannula, or a supraglottic mask/tube.
  • the present techniques may also be used to monitor any patient benefiting from mechanical ventilation, e.g., positive pressure ventilation.
  • the devices and techniques provided herein may be used to monitor a human patient, such as a trauma victim, an intubated patient, a patient with a tracheotomy, an anesthetized patient, a cardiac arrest victim, a patient suffering from airway obstruction, or a patient suffering from respiratory failure.
  • a human patient such as a trauma victim, an intubated patient, a patient with a tracheotomy, an anesthetized patient, a cardiac arrest victim, a patient suffering from airway obstruction, or a patient suffering from respiratory failure.
  • FIG. 1 shows an exemplary tracheal tube system 10 that has been inserted into a patient's trachea.
  • the system 10 includes a tracheal tube 12, shown here as endotracheal tube, with an inflatable balloon cuff 14 that may be inflated to form a seal against tracheal walls 16.
  • the tracheal tube 12 may also include one or more optical source fibers 18 and optical detection fibers 20 that are associated with the tube 12.
  • a ventilator 22 is typically provided, as discussed below.
  • the optical source fiber 18 may be configured to pass light from a source 24 through a distal end 27 of the endotracheal tube and into a patient's trachea such that a portion of the emitted light may interact with a carina 28.
  • the emitted light may be transferred back through the optical detection fiber 20, which may be coupled to a light detector 26.
  • any ventilator may be used, such as those available from Nellcor Puritan Bennett LLC.
  • the system may also include a monitor 30 that may be configured to implement embodiments of the present disclosure.
  • the monitor 30 may be a stand-alone device or may be coupled to another patient monitor or to the ventilator 22.
  • the monitor 30 may include a microprocessor 32 coupled to an internal bus 34 and a display 36. Regardless of where it is placed, the microprocessor, or any other suitable processing circuitry, aids in computing the distance of the distal end 27 of the tube from reference structures within the patient, such as the carina 28.
  • the monitor 30 may include certain elements for controlling the light source 24 and the light detector 26.
  • the monitor 30 may drive light from source 24, which in turn may be carried by optical source fiber 18.
  • the light may pass into the tissue, where it may be variously scattered, absorbed, and/or reflected and then detected by detector 26.
  • a time processing unit (TPU) 38 may provide timing control signals to light drive circuitry 40, which controls when the light source 24 is activated, and if multiple light sources 24 are used, the multiplexed timing for the different light sources.
  • TPU 38 may also control the gating-in of signals from detector 26.
  • the monitor 30 may be configured to receive signals from the detector 26 and store the signals in a mass storage device 42, such as a RAM, ROM, optical storage device, flash memory device, hardware storage device, a magnetic storage device, or any other suitable device permitting memory storage.
  • the signals may be accessed and operated according to instructions (which may also be stored in the memory circuitry) executed by the microprocessor 32.
  • the signals may be related to a placement of the tracheal tube 12 within the patient's trachea and may be processed by the monitor 30 to indicate whether the tracheal tube 12 is properly placed.
  • the monitor 30 may be configured to provide an indication about the placement of the tracheal tube 12 within the patient's trachea, such as an audio alarm, visual alarm or a display message if the tracheal tube 12 is too far or too close to certain anatomical structures, such as the carina 28, or outside of a predetermined placement range.
  • microprocessor 32 may calculate a placement parameter of the endotracheal tube 12 using various algorithms.
  • the placement parameter may relate to, measure, or provide an indication of a distance 44 between the distal end 27 of the tube 12 and the carina 28 or other anatomical structure.
  • FIG. 2 is a schematic representation of an exemplary interferometry arrangement that may be incorporated into system 10 for analyzing placement of a tracheal tube 12 within a patient's trachea.
  • a reference beam may be combined with a sample beam to generate interference peaks, corresponding to the measured distance.
  • a beam splitter 46 divides light from light source 24 between a reference beam 50 and the sample beam 52.
  • the reference beam is configured to impinge a reflective surface 54 (e.g., a mirror), which is a distance Lm from the detector 26.
  • the beam splitter 46 may be configured to emit the reference beam 50 towards the reflective surface 54, for example along an axis 58 in a direction substantially orthogonal to the sample beam 52.
  • the placement of the reflective surface 54 may also be generally orthogonal to the axis 62 of the sample beam 52.
  • the distance Lm may change as the reflective surface 54 is moved toward or away from the detector 26.
  • the reflective surface 54 may be under the control of a reference beam controller 60 that may control the movement of reflective surface 54 and may be in communication with monitor 30, which includes light drive circuitry 32 for driving light source 24.
  • the reference beam controller 60 may provide information to the monitor 30 about changes in the distance Lm.
  • the depicted arrangement is merely an example of a particular low-coherence interferometry arrangement and other suitable arrangements may be employed.
  • a 2x2 fiber coupler may be used in place of a beam splitter 46.
  • the beams may run along any axis since fibers may be flexible. Accordingly, orthogonal relationships between reference and sample arms may not hold. However, light emitted from a fiber may be normal to the reflective surface 54 in order to have the reflected light coupled back into the fiber.
  • the light that is reflected from the reflective surface 54 may impinge a detector 26 to generate the reference signal, while the light that is returned through optical detection fiber 20 may impinge a detector 26 to generate the sample signal.
  • the sample signal and the reference beam signal are both generated at a single detector 26.
  • TPU 38 may control gating-in of the reference beam signal and the sample signal. Both signals are combined and directed to the detector 26, which will typically include one or more photodetectors (e.g., photodiodes) that generate measurement signals based upon the received radiation.
  • the reference signal and sample signal may be analyzed by the microprocessor 32 (e.g, via the measurement signal from the detector). In one embodiment, the signals may be combined to form an interferogram.
  • the distance Lm is substantially equal to a distance Lc, which may be defined as a distance between an end of the tube and the carina 28. Because Lm is known, Lc may be determined, as discussed in more detail below.
  • the light source 24 and a detector 26 may be of any suitable type.
  • the light source 24 may be one or more light emitting diodes adapted to transmit one or more wavelengths of light, for example in the red to infrared range
  • the detector 26 may be one or more photodetectors selected to receive light in the range or ranges emitted from the light source 24.
  • a light source 24 may be a coherent light source, such as a laser diode or a vertical cavity surface emitting laser (VCSEL).
  • the light source 24 may include a broadband or "white light" source, in which case the detector could include any of a variety of elements for selecting specific wavelengths, such as reflective or refractive elements or interferometers.
  • the term "light” may refer to one or more of ultrasound, radio, microwave, millimeter wave, infrared, visible, ultraviolet, gamma ray or X-ray electromagnetic radiation, and may also include any wavelength within the radio, microwave, infrared, visible, ultraviolet, or X-ray spectra.
  • the light source 24 may include a low-coherence laser source such as a NdIYVO 4 pumped titanium: sapphire laser that yields radiation having a wavelength range from approximately 650 nm to approximately 900 nm after passing through a fiber.
  • a low-coherence laser source such as a NdIYVO 4 pumped titanium: sapphire laser that yields radiation having a wavelength range from approximately 650 nm to approximately 900 nm after passing through a fiber.
  • FIG. 3 is a process flow diagram illustrating a method in accordance with some embodiments.
  • the method is generally indicated by reference number 64 and includes various steps or actions represented by blocks.
  • the method 64 may be performed as an automated procedure by a system, such as system 10. Further, certain steps or portions of the method may be performed by separate devices. For example, a first portion of the method 64 may be performed by a light source 24 and light detector 26, while a second portion of the method 64 may be performed by a monitor 30.
  • the method 64 may be performed continuously or intermittently for long- term patient monitoring or at any appropriate interval depending on the particular situation of the intubated patient. Further, the steps of method 64 may be performed during insertion of the tracheal tube 12 into the patient.
  • the method 64 begins with emitting light, such as coherent light, at step 66 from a light source 24 coupled to one or more optical fibers 18.
  • the emitted light is split at step 68 into a reference light beam 50 and a sample beam 52.
  • the sample beam is transmitted through fiber 18, which is associated with tube 12 that is inserted into a patient's airway.
  • the sample beam 52 may exit the distal end 27 of the tube 12 before interacting with anatomical structures in the patient.
  • Any light that is returned through detection fiber 20 and received by the detector 26 at step 70 may carry information about the relative position of the tube 12 and the anatomical structure that is carried in the sample signal, generated at step 72.
  • the reference beam 50 is detected by the detector 26 to generate the reference signal at step 76.
  • reference light beam 50 and the sample beam 52 may be combined at the detector 26 to yield interference peaks (e.g., an interferogram). Accordingly, in certain arrangements, steps 72 and 76 may be at least partially combined.
  • a monitor 30 may perform analysis of the sample signal and the reference signal at step 78.
  • the monitor may amplify and/or filter one or both of the sample signal and the reference signal prior to the analysis, as well as the measurement signal generated by combining the two.
  • an interferogram may be generated by the monitor 30. The interferogram may be used to determine the point of maximum interference between the sample signal and the reference signal. Generally, this point may correspond to a point where a distance between an emitter 24 and the carina 28, Lc, is substantially equal to a distance between a reflective surface 54 and a detector 26, Lm.
  • certain arrangements using beamsplitters, fiber couplers, or optical fibers may influence the determinations of Lm or Lc.
  • Lm is the distance between the beam splitting point and the reflective surface 54
  • Lc is the distance from the carina 28 to the same beam splitting point. It should also be understood that, because the emitter 24 and detector 26 may be coupled to optical fibers that may not substantially alter the intensity of light as a function of their length, in embodiments, determining the distance 44 from Lc may involve subtracting a length of the optical fiber. That is, the measured length or distance can be easily converted to a distance 44 between the end of the tube and the anatomical structure of interest by subtracting the light transmission length represented by the optical fibers, any connectors, and so forth.
  • a monitor 30 may use the distance Lc as a placement parameter at step 80 to determine whether this distance is acceptable by reference to a desirable placement of the tracheal tube 12.
  • Example of placement parameters may include a calculated distance between a tube 12 and an anatomical structure.
  • a placement parameter may be a ratio of a calculated distance 44 determined from Lc and an empirically derived or clinically measured distance associated with proper tube placement. For example, proper tube placement may involve a measured distance 44 of 1-5 cm. It should be appreciated that there may be several empirically derived target distances, depending on the size, age, or sex of the patient.
  • a target distance to which the measured distance 44 may be compared may differ for adult men, who may have, in an embodiment, a predetermined target of 3 -4cm, and adult women, for whom the predetermined target may be 2-3 cm. In other embodiments, the alarm may be triggered if the measured distance 44 is less than 3 cm, less than 2cm, or less than lcm.
  • a placement parameter may also be an average or mean of multiple data points or measurements.
  • a placement parameter may also include a graphical, visual, or audio representation of the tube/anatomical structure distance.
  • a placement parameter associated with proper placement may include green light indicated on a display or a short tone generated by a speaker associated with monitor 30.
  • a placement parameter associated with improper placement of the tube 12 may trigger an alarm at step 82, which may include one or more of an audio or visual alarm indication. In one embodiment, the alarm may be triggered if the placement parameter is, substantially less than or substantially greater than a predetermined value, or outside of a predetermined range.
  • the controller 60 may collect interferometry data at multiple reflective surface 54 positions and the data may form multiple reference signals. That is, the distance Lm traveled by the reference beam may be varied and matched to the distance Lc to the anatomical feature such that the two remain matched during intubation, providing a substantially continuous measurement of the distance of interest.
  • Such measurements may include closed- loop control of the length of the reference length Lm by appropriate control.
  • such an embodiment may be employed for determining a placement parameter during intubation.
  • the reflective surface 54 may be moved until the distance Lc is equal to the distance Lm.
  • the reflective surface 54 may be continuously scanned back and forth. The interference peaks will move, corresponding to the distance Lc changes.
  • FPGA field-programmable gate array
  • FIG. 4 is a perspective view of an exemplary tracheal tube 12 according to certain embodiments.
  • the tube 12 may include a cuff 14 that may be inflated via inflation lumen 84.
  • the tracheal tube 12 may also include a suction lumen 86 for aspirating secretions that may form above the cuff 14.
  • the tracheal tube 12 may also include a plurality of fiber bundles 88. In certain embodiments, individual fibers rather than fiber bundles 88 may be used. Each fiber bundle may include one or more optical source fibers 18 and optical detection fibers 20. In certain embodiments, the transmitting and detecting may also take place within a single fiber.
  • the fiber bundles 88 may extend through the walls 90 of the tracheal tube 12 such that they are substantially in line with a flow path 92 of the tracheal tube 12.
  • the fiber bundles 88 may include any appropriate optical connector 94 for connecting the fiber bundles 88 to components of the system 10, such as the beam splitter 46 or the light source 24 or light detector 26.
  • the tube 12 and the cuff 14 may be formed from materials having suitable mechanical properties (such as puncture resistance, pin hole resistance, tensile strength), chemical properties (such as biocompatibility).
  • the walls of the cuff 14 are made of a polyurethane having suitable mechanical and chemical properties.
  • An example of a suitable polyurethane is Dow Pellethane" 2363-80A.
  • the walls of the cuff 14 are made of a suitable polyvinyl chloride (PVC).
  • the cuff 14 may be generally sized and shaped as a high volume, low pressure cuff that may be designed to be inflated to pressures between about 15 cm H 2 O and 30cm H 2 O.
  • the system 10 may also include a respiratory circuit (not shown) connected to the endotracheal tube 12 that allows one-way flow of expired gases away from the patient and one-way flow of inspired gases towards the patient.
  • the respiratory circuit including the tube 12, may include standard medical tubing made from suitable materials such as polyurethane, polyvinyl chloride (PVC), polyethylene teraphthalate (PETP), low-density polyethylene (LDPE), polypropylene, silicone, neoprene, polytetrafluoroethylene (PTFE), or polyisoprene.
  • FIG. 5 is a side view of the distal end 27 of the tracheal tube 12.
  • the fiber bundles 88 may extend through the walls 90 of the tracheal tube.
  • the fiber bundles 88 may be embedded or coextruded within an extruded tracheal tube 12.
  • the distal end 27 may be cut on a slant to facilitate insertion of the tube 12 in the trachea. After the tube is cut, the fiber bundles 88 may be terminated by any suitable technique.
  • the fiber bundles 88 may be distributed around the circumference 96 of the tube wall 90. In an embodiment, three optical bundles may be substantially evenly spaced about the circumference 96. As shown, the positioning of the fiber bundles 88 or single fibers may influence the path of the light from the distal end 27 of the tube 12 to the anatomical structure. Arrows 98, 100, and 102 illustrate three different light paths from bundles 88a, 88b, and 88c, respectively, to anatomical structures at or proximate to the carina 28.
  • Arrow 98 has a somewhat shorter path than arrow 100, which is related to its position around the circumference 96 relative to the carina 28, as well as differences in the topography of the carina 28.
  • slight changes in the angle within the trachea of the distal end 27 of the tube 12 may influence the path of light to and from the fiber bundles 88.
  • light detected from all three fiber bundles 88 may be combined or averaged to generate the data used to determine a placement parameter.
  • the differences in path length between multiple bundles may be used to determine a placement parameter that is indicative of the orientation of the distal end 27 within the trachea. Changes in this orientation (e.g., angular displacement) may indicate a shift in tube placement that may influence cuff pressure and sealing.
  • the fibers or fiber bundles 88 may be formed from materials such as quartz, glass, or a transparent plastic, such as poly(methyl methacrylate) or polystyrene with a fluoropolymer cladding.
  • optical fibers include single- mode fibers, multi-mode fibers, photonic-crystal fibers, hollow-core fibers, polarization- maintaining fibers and dual-clad fibers. Typical diameters for optical fibers are from 5 to 1,000 micrometers.
  • the optical fiber may be a single-mode fiber or a multi-mode fiber.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Pulmonology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Optics & Photonics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Endoscopes (AREA)
  • Investigating Or Analysing Materials By Optical Means (AREA)

Abstract

Selon divers modes de réalisations, un tube trachéal (12) peut employer des techniques de détection optique pour déterminer une distance (d) entre le tube introduit et une structure anatomique telle qu'une carina (28). Cette information sur la distance peut indiquer si le tube trachéal est oui ou non correctement placé à l'intérieur de la trachée. Les techniques optiques peuvent inclure l'interférométrie.
PCT/US2010/030064 2009-04-08 2010-04-06 Dispositif médical et technique pour utiliser celui-ci Ceased WO2010117999A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US12/420,148 US8457715B2 (en) 2009-04-08 2009-04-08 System and method for determining placement of a tracheal tube
US12/420,148 2009-04-08

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WO2010117999A1 true WO2010117999A1 (fr) 2010-10-14

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Cited By (2)

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Publication number Priority date Publication date Assignee Title
US9526856B2 (en) 2011-12-15 2016-12-27 The Board Of Trustees Of The Leland Stanford Junior University Devices and methods for preventing tracheal aspiration
US9770194B2 (en) 2013-11-05 2017-09-26 Ciel Medical, Inc. Devices and methods for airway measurement

Families Citing this family (63)

* Cited by examiner, † Cited by third party
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